TRT Not Working as Good

I am 61, slim and fairly good shape weight 160 5 ft 10 in
I started TRT going on 4 weeks ago. I take 50 mg 3 times per week,150 mg per week. When I first started about 2 weeks in my libido went out the roof, ED Improves as well. My mood was much better. But starting week 4 my libido and ED issues are declining again. Mood still ok. Curious what is going on? My urologist put me on this. My total T was 281, my free T was 3.6. I know I’ve only been in this a short time but don’t understand the peak and decline of my symptoms. I was really excited this was working but having second thoughts now. Another question I had is why my urologist didn’t do 2 blood tests to insure it wasn’t a fluke. I asked him and he told me when someone has symptoms and low numbers he doesn’t do a second test. Thanks

You need to be more realistic, this is very early in treatment to be expecting maximum benefits.

You’re also going through the TRT honeymoon peroid which is common, and over the next couple of months provided your dosage is optimal for you, symptoms will start to improve again.

It’s also common for guys that push high T levels to have diminished sexual parameters, some guys on blast and cruise report lower libido and sexual function.

So getting the dosage, and injection frequency right for you is critical.

Significant improvement in libido is usually experienced within 3–6 weeks of commencing TTh whereas ED improvement can be observed after 12 weeks. Up to 12 months of TTh may be required before significant improvement in ejaculatory function is observed. Some publications show continued improvement of erectile function for up to 4-9 years. Significant improvement in quality of life (QoL) usually occurs within 3–4 weeks of starting TTh; longer-term TTh is required to achieve maximum QoL benefit. Effects on depressive mood become detectable after 3–6 weeks of starting TTh, with maximum improvement occurring after 18–30 weeks. Improvements in bone are detectable after 6 months of TTh, while the full beneficial effect of TTh on bone mineral density may take 2–3 years or even 6 years as suggested by Haider et al.

-Effects of TTh on lipids appear after 4 weeks, with maximal effects being seen after 6–12 months of 124 B. LUNENFELD ET AL. treatment. Insulin sensitivity may improve within a few days of starting TTh, but effects on glycaemic control become evident only after 3–12 months. Failure to improve clinical symptoms within a reasonable period should result in a reevaluation of TTh with regard to dosage.

This may be a problem for you if your insurance is paying for treatment, because insurance companies require two separate tests showing low testosterone.

Your insurance company could deny coverage due to this little oversight by your doctor and force you to stop treatment abruptly to prove you have low testosterone before coverage can be approved.

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You’re hesitation is understandable, but know that lower than normal testosterone increases your risk of cardiovascular problems and a worse health outcome.

You’re working with both endogenous (though not a whole lot) and exogenous testosterone when you start. Your endogenous testosterone is shutting down now, so you have exogenous only working for you. Give it a few more weeks for the exogenous testosterone to build up.

You did not reference lab ranges but your total is probably low normal within range. Quest is 250-1100ng/dL. Even if a second test came back higher, you still aren’t feeling any better. You’re 61, with symptoms, insurance companies likely will not question TRT. Doubt it is even flagged. They won’t fight that, you’ll be Medicare’s problem soon. Very nice that your doctor gave you the dose he did, and not the once every two to four weeks schedule.

Good luck and hang in there. Vast majority in your shoes do very well.

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Report Result Ref. Range Units Status Lab
ALBUMIN 4.2 (3.5-5.0 g/dL) Final LRLAB
SHBG 63.20 (11.00-80.00 nmol/L) Final LRLAB
TESTO 281 (280-800 ng/dL) Final LRLAB
Please note the change in units from ng/mL to ng/dL, normal ranges have also
changed.

FTESTO 3.6 (4.7-24.4) ng/dL Low Final LRLAB
FT% 1.27 % Final LRLAB
BIO TESTO 81 (130-680) ng/dL Low Final LRLAB
BAT% 29.0 % Final LRLAB

My urologist didn’t really explain the ramifications of going in trt. Acted like try it and see how u feel and if u don’t like it get off it. Didn’t understand it was turning off my system replacing it with an external system. Offered me no options like maybe some drug to enhance my natural T. I should have done more research myself before making this decision. I do feel better. But I felt rushed.

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Normally clomid is used for younger men and not so much for older men with mileage on the testicles.

Also older guys have less of a chance to increase T naturally.

Your Free T levels are about the same as mine at the time of my low-T diagnosis with the only difference being SHBG was 11 and Total T at 91 ng/dL.

If you have LH labs, this will determine if you have secondary (pituitary failure) or primary (testicular failure).

It’s easy to stop TRT if you want to reassess, especially when only 4 weeks in. Either stop taking the shots and let things start up naturally, or ask your doc for a couple of weeks Tamoxifen. Don’t feel tied into TRT if it’s not working for you. TRT can be a great tool for many but it can be huge drain on energy, resources and headspace with little reward for lots of others.

You really need to wait until week 6 and get blood work to measure where you are objectively. Hope it works out for you whatever you decide.

Thanks

I recommend anyone about to start TRT to watch, “Testosterone controversies in Men’s Health, a lecture by Dr. Khera”.

This was an excellent video! Wish I had seen this before

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My insurance company didn’t question it at all.

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Back in 2019 I had my T checked bc I had low libido and ED. Came back 400 and free t was 12. Primary care doc said I was normal. Looking back i think he was full of crap

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More Science-Based “Low Normal” Testosterone Facts

  • “Low normal” total testosterone concentrations are associated with reductions in motivation, initiative, self-confidence, concentration and memory, sleep quality, muscle bulk and strength, diminished physical or work performance, feeling sad or blue, depressed mood, mild anemia, and increased body fat and body mass index.

  • Low normal serum testosterone concentrations are associated with reduced male sexual desire, function, performance and potency.

  • Low normal serum testosterone concentrations increase the risk for premature death from any cause.

  • Low normal serum testosterone concentrations increase the risk for death from cardiovascular disease, and increase the combined risk for suffering a first stroke or first transient ischemic attack.

  • Low normal serum testosterone concentrations increase the risk for both memory loss and developing clinical depression.

  • Low normal serum testosterone concentrations increase the risk of developing an increased level of systemic inflammation.

Defining “Healthy” Testosterone

Multiple peer-reviewed papers state that “testosterone deficiencies” are more prevalent and “desirable testosterone” levels in men are actually much higher than what is currently being considered as “normal” in doctors’ practices across the country. Case in point: A cross-sectional study of Swedish men ages 69 to 80 years showed the risk for premature death from any cause26 and the risk for suffering a major cardiovascular event27 were inversely correlated with the total serum testosterone concentration (i.e., the higher the testosterone levels, the lower the risk of death).

Specifically with regards to cardiovascular events, men in the highest quartile of testosterone (at or higher than 550 ng/dL) had a lower risk of cardiovascular events compared with men with lower testosterone.

More importantly, details from this study show that it did not matter if a man’s total testosterone was very low (below 340 ng/dL ) or moderately low (up to 549 ng/dL ) – all men with T levels below 549 ng/dL had a similar increased risk for suffering a cardiovascular event. Only when total testosterone exceeded 550 ng/dL did cardiovascular risk drop.

This is truly alarming, as cardiovascular disease is the No. 1 killer of men in the United States and even more – this study was published in the Journal of the American College of Cardiology. These researchers documented a 30 percent reduction in cardiovascular events as well as a decrease in cerebrovascular disease incidence. Men with the highest total testosterone had a 24 percent reduced risk of transient ischemic attack or full-blown stroke.27 Clearly, based on this study, the only target for “healthy testosterone” is to maintain total testosterone at or above 550 ng/dL.

As a health care practitioner, please note the following:

  • According to LabCorp, the “healthy reference range” for total testosterone is 348–1,197 ng/dL. So, the lower part of this range completely ignores recent science that shows total testosterone levels need to be maintained above 550 ng/dL.

  • Subjectively, this broad range is ridiculous. As any 45-year-old man who has suffered with low normal testosterone knows, there is a world of difference in how a man feels and performs (both mentally and physically) when testosterone is “low normal” versus higher up the healthy “normal” reference range.

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Give it 3 months. I had off and on libido, but that didnt get better and more consistent after several months. then at 1 year it was ridiculous. I also had tchy/ sensitive nipples, anxiety, water retention. After 3 months it vanished, like it did for my other friends and my doctors other clients.

Dont make cahnges now. Wait for labs… give it 2-3 months. If you dont feel better then, increase the dosage to 200 and that should do the trick.

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what is causing all this low t ? i dont remember my dad or his generation ever dealing with this.

Lifestyle, food, and environment/chemicals.

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So if one eliminates theses causes would Natural t come back

I don’t disagree with @systemlord at all but…

We could also argue that humans live much longer than we’re supposed to… During hunter/gatherer societies (which compose of 190,000 years of our history - compared to the last 10,000 years), the average lifespan was 31 years. Nowadays we live for 72.6 years on average… I think we’re just living beyond our expiration date really.

BUT

Birth control pills actually add a lot of estrogen to the water supply, which most people living in cities get their water from. Science goes back and forth a bit, but I think there’s a strong correlation between the two. That, and everything that @systemlord said.

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